[Establishment of university departments of urology in North Rhine-Westphalia: the Aachen model]. / Etablierung von Urologischen Universitätskliniken in NRW : Das Aachener Modell.

The foundation of university departments of urology in postwar East and West Germany faced some opposition by some university professors of surgery who wanted to preserve the unity of their discipline. In North Rhine-Westphalia, heads of municipal hospitals or senior members of university hospitals' staff often received the first chaired professorships of urology.

[Urology and National Socialism illustrated by the example of Leopold Casper (1859-1959)]. / Urologie und Nationalsozialismus am Beispiel von Leopold Casper (1859-1959).

Leopold Casper (1859-1959) was one of the founders of the German Urological Society (DGfU) in 1906. He introduced functional kidney testing and a special cystoscope for ureteral catheterization. In 1913 he was president of the 4th congress held in the German capital Berlin. His textbook on genito-urinary diseases was translated by Charles W. Bonney in 1910 and proved the high quality of his scientific work. As a Jew he was forced to leave Nazi Germany later on in 1933 and from 1941 onwards he lived in New York. The anniversary of his 150th birthday should be remembered with special focus on the exodus of Jewish German scientists during the Nazi period.

[Gustav Simon--Surgery of the kidneys]. / Gustav Simon--Chirurgie der Nieren, Band I Gedruckt bei Ferdinand Enke zu Erlangen 1871.

In the English-speaking world anthologies about "classic works in urology" have been en vogue for years and have been published several times, but they do not exist in Germany. Due to the short half-life of knowledge, these pioneering publications were forgotten and are not readily available or easily accessible. Furthermore, for reasons of preservation libraries do not allow borrowing these old books or copying them. These articles thus remain inaccessible to the public. The work of the famous Gustav Simon ranks along with Nitze's "Kystoscopy" among the most important works for our specialty. The Museum and Archives of the German Urologic Society, located at the head office in Dusseldorf, has a well-renowned collection of papers, monographs, and books from across the centuries.

[History of ureteropelvic junction obstruction repair (pyeloplasty). From Trendelenburg (1886) to the present]. / Die Geschichte der operativen Behandlung der Harnleiterabgangsstenose (Pyeloplastik). Von Trendelenburg (1886) bis zur Gegenwart.

The first reconstructive procedure for ureteropelvic junction (UPJ) obstruction was performed by Trendelenburg in 1886. The important milestones in the reconstruction of UPJ are discussed and all available historical papers and reports since 1886 are reviewed. Kuster published the first successful dismembered pyeloplasty 5 years later, but his technique was prone to strictures. In 1892, the application of the Heineke-Mickulicz principle by Fenger resulted in bulking and kinking with obstruction. Plication of the renal pelvis, first introduced by Israel in 1896, was modified by Kelly in 1906. After the principle of the Finney pyloroplasty, von Lichtenberg designed his pyeloplasty in 1921, best suited to cases of high implantation of the ureter. Foley modified flap techniques, first introduced by Schwyzer in 1923 after the application of the Durante pyloroplasty principle, successfully to Y-V pyeloplasty in 1937. Culp and de-Weerd introduced the spiral flap in 1951. Scardino and Prince reported about the vertical flap in 1953. Patel published the extra-long spiral flap technique in 1982. In order to decrease the likelihood of stricture, Nesbit, in 1949, modified Kuster's procedure by utilizing an elliptic anastomosis. In the same year, Anderson and Hynes, published their technique. With the advent of endourology, several minimally invasive procedures were applied: antegrade or retrograde endopyelotomy, balloon dilation, and laparoscopic pyeloplasty. The concept of full-thickness incision of the narrow segment followed by prolonged stenting was first described in 1903 by Albarran and was popularized by Davis in 1943. Several basic principles must be applied in order to ensure successful repair: the resultant anastomosis should be widely patent, performed in a watertight fashion without tension. Endopyelotomy represents an alternative to open surgery.

[Urinary cytology in cases of bladder cancer: a critical evaluation]. / Urinzytologie beim Harnblasenkarzinom. Kritische Wertung.

Is urinary cytology still a useful method in cases of bladder cancer since additional methods (fluorescence image analysis, monoclonal antibody immunocytology, fibrin degradation products, nuclear matrix protein measurement and others) are under investigation? The literature has been reviewed and compared with classical and new cytology statistics: urinary cytology is less useful than cystoscopy and some of the urine bound tests for the diagnosis of low grade tumors. On the other hand, cytology is extremely valuable for the diagnosis of high grade transitional cell cancers (TCC) and especially carcinomas in situ. The presence of high-grade TCC in the cytology specimen from a patient with low grade papillary TCC suggests either an unrecognised carcinoma in situ or high grade disease in the upper urinary tract or urethra. Urinary cytology is still indispensable in the management of patients with transitional cancer.

The surgeon and his intention: Gustav Simon (1824-1876), his first planned nephrectomy and further contributions to urology.

One of the historic landmarks in urology is the first planned nephrectomy performed in 1869 by Gustav Simon of Heidelberg (1824-1877). In the history of medicine the reflections and considerations of the specialized surgeon reveal distinguished analyses of the "case" and, thus, the beginning of a modern scientific discussion of a patient's quality of life. Available primary and secondary sources were screened to present a differentiated aspect of this milestone in the history of urology. The analysis of the first German indicated nephrectomy shows the introduction of scientifically orientated thinking in urology, especially in Germany during the middle of the nineteenth century, and parallels the rise of urology and general surgery.

[Malignant mesothelioma of the tunica vaginalis testis]. / Malignes Mesotheliom der Tunica vaginalis testis.

A case of malignant mesothelioma of the tunica vaginalis testis is reported in a 77-year-old male patient. There was no history of asbestos exposure. Recurrent right hydrocele with a papillar inguinal mass was the main clinical feature. An inguinal radical orchiectomy with en bloc resection of the surrounding tissue was performed. The therapeutic options for this rare, but aggressive neoplasm are discussed. Because of the disappointing results of antineoplastic chemotherapy or radiation therapy, the importance of initial radical surgical treatment with complete excision is emphasized.

[Results of ureterocystoneostomy for inner urinary diversion in locally advanced prostate carcinoma]. / Ergebnisse der Ureterozystoneostomie zur inneren Harnableitung beim lokal fortgeschrittenen Prostatakarzinom.

Ureterneoimplantation (unilateral in 6 cases) was performed as palliative urinary diversion in 8 patients (age 64-81 years) due to locally advanced prostate cancer and bilateral ureteral obstruction (serum creatinine 2.1 to 9.8 mg. per dl.) between 1991 and 1995. In these cases the application of a double-J-catheter had failed or a percutaneous nephrostomy was refused. Postoperative time of survival (237 days, 2 patients still living for 20 and 21 months after therapy), mortality (1 of 8 patients), morbidity and time to hospital discharge (26 days) are compared to the results of the published retrospective investigations concerning percutaneous nephrostomy. The opportunity of a natural micturition without external urinary diversion could be gained for a longer period of time (5 and 20 months) in 2 of 3 patients. The other patients with in situ double-j-catheters were drained sufficiently by a suprapubic cystostomy (serum creatinine postoperatively 1.3 to 2.0 mg. per dl.). Bilateral ureterocystoneostomy being more invasive than unilateral diversion showed no benefits and was no more performed since 1991. Uretemeoimplantation with comparable postoperative results to percutaneus nephrostomy seems to be a sufficient therapeutic possibility in patients with natural micturition, repeated catheter complications, refusal or failure of alternative urinary diversion.

[Chronic interstitial cystitis (Hunner) associated verrucous carcinoma of the urinary bladder]. / Das mit der chronisch interstitiellen Zystitis (Hunner) assoziierte verruköse Karzinom der Harnblase.

A verrucous carcinoma of the urinary bladder (pT4N0M0, G1) developed in a 66-year-old woman who had been suffering from interstitial cystitis with Hunner's ulcer for 10 years. Up to now, only 7 cases of verrucous carcinoma of the urinary bladder unassociated with bilharzial cystitis have been reported. Although the development of a verrucous carcinoma as a complication of interstitial cystitis has not been reported so far, the authors regard the chronic irritation of the bladder to be the most important etiologic factor for the malignant transformation. After conservative management had failed, a radical cystectomy with supravesical urinary diversion was performed. The characteristics of interstitial cystitis, verrucous carcinoma and surgical management are discussed.

[Therapy and follow-up of superficial bladder cancer in in patients less than 30 years of age]. / Therapie und Verlauf des oberflächlichen Harnblasenkarzinoms bei Patienten unter 30 Jahren.

Transitional cell carcinoma of the bladder is relatively uncommon in patients under 30 years old. We treated 11 patients with superficial bladder carcinoma under 30 years of age. In 10 cases gross haematuria was the most common presenting symptom. The pathological reports of the patients revealed grade I, stage Ta transitional cell carcinoma in seven patients, grade I, stage T1 tumour in two patients and bladder myoma and inverted papilloma in two patients each. Four of nine patients with superficial bladder carcinoma stayed free of disease for 1-10 years after initial transurethral resection (TUR). Four patients suffered multiple tumour recurrences 1-4 months after initial TUR, with progressive disease in three cases. One patient was lost to follow-up after primary operation. In the two patients with benign bladder tumours, no recurrences were observed within 12 and 48 months. Owing to the high rates of recurrence (44%) and tumour progression (33%) all patients under 30 years of age should be treated as aggressively as necessary on the basis of the grade and stage of the tumour, in the same way older patients.

Prostate-specific antigen corrected for prostate volume improves differentiation of benign prostatic hyperplasia and organ-confined prostatic cancer.

OBJECTIVE: To determine whether the ratio of PSA and prostate volume provides additional useful information for the discrimination of benign prostatic hyperplasia from prostatic carcinoma. PATIENTS AND METHODS: Since 1989, a prospective study has been in progress involving 229 patients (49 with locally confined prostatic carcinoma, 180 with benign prostatic hyperplasia) to establish whether the ratio of prostate-specific antigen (PSA) and prostate volume, determined by transrectal ultrasound (longitudinal x anterior-posterior x transverse diameter x 0.52), allows a better differentiation than the absolute PSA values. RESULTS: In this population of patients with prostatic disease, the positive predictive value for diagnosis of a prostatic carcinoma was 26% with an absolute PSA threshold value of 4.0 ng/ml, and 36% at a threshold value of 10 ng/ml. With a threshold value of the PSA/prostate volume ratio of 0.25 ng/(ml x cm3), the positive predictive value was 56% compared with 93% for a threshold value of 0.4 ng/(ml x cm3). CONCLUSION: The ratio PSA/prostate volume is a superior method for the diagnosis of prostatic carcinoma both with regard to its sensitivity and its specificity in patients with absolute PSA values in excess of 4 ng/ml.

Elimination kinetics of prostate-specific antigen serum and urine.

The serum half-life of prostate-specific antigen (PSA) was calculated in 66 patients subsequent to radical prostatectomy. Comparing serum half-life to disease outcome in 37 patients after a minimum follow-up of two years, it was found that PSA serum half-life identifies patients with residual disease earlier and more reliably than the presence or absence of detectable PSA levels postoperatively. It is suggested that residual tumor affects the half-life by contributing to the serum level of PSA. When PSA serum half-life was calculated solely in potentially cured patients, we found a half-life of 1.6 days, which is considerably shorter than in previous reports based on patient populations regardless of the outcome of disease in the follow-up. To elucidate the route of PSA elimination, serial urine PSA levels were determined before and after radical prostatectomy, revealing strong evidence for the assumption that PSA is not eliminated by the kidneys in its unchanged form.

[The quotient of prostate-specific antigen and prostate volume. Improved differentiation between benign prostatic hyperplasia and locally circumscribed prostate cancer]. / Der Quotient aus prostata-spezifischem Antigen und Prostatavolumen. Verbesserte Unterscheidung zwischen benigner Prostatahyperplasie und lokal begrenztem Prostatakarzinom.

Absolute serum prostate-specific antigen (PSA) values are of little help in the identification of locally confined prostatic cancer (PCA), because of a considerable overlap with the PSA values found in benign prostatic hyperplasia (BPH). Prostate gland volumes were estimated sonographically in 112 patients using the product of the three maximal diameters (longitudinal, anterior-posterior, transverse) and the factor 0.52. PSA was determined with a monoclonal immunoenzymetric assay (Tandem-E, Hybritech). The prostates were removed by either transvesical prostatectomy (for BPH) or radical retropubic prostatovesiculectomy (for PCA). In each case the diagnosis was verified by systematic histological examination. The ratio of serum PSA to estimated prostate volume did not exceed 0.4 ng/(ml x ml) in any of the 74 patients with BPH, whereas 23 of the 38 patients with PCA had a ratio above 0.4 ng/(ml x ml). The information provided by the PSA-prostate volume ratio is superior to absolute PSA values in preoperative differentiation between BPH and PCA. With a PSA-prostate volume ratio over 0.4 ng/(ml x ml) patients are at high risk for PCA and should be evaluated by prostate biopsy.

[Suture surface and suture strength of polypropylene monofilaments]. / Knotenoberfläche und Knotenzugfestigkeit von Polypropylen Monofilamenten.

Knots form the weakest sections in suture materials. The addition of forces in the knot caused by bend and tension exceed the strength of the suture material and lead to rupture in the knot. Furthermore the most pronounced tissue reactions occur in the surrounding of knots because of their relatively large surface as compared to the linear filament. With a higher knot holding capacity a secure fixation can be achieved with less knots. As a reduced number of knots leads to a smaller surface a reduced tissue reaction can be expected. Because of high rigidity and a low coefficient of friction synthetic monofilaments achieve only a low knot holding capacity. To improve the knot holding capacity a usually large number of knots is being used. With increasing surface of exogenous materials the extent of foreign-body reactions increases, e.g. formation of granuloma. Results of in-vitro experiments are reported that were conducted to identify the smallest secure knot in polypropylene filaments of various diameters.

Prediction of tumor recurrence after radical prostatectomy using elimination kinetics of prostate-specific antigen.

The serum half-life of prostate-specific antigen (PSA) calculated subsequent to radical prostatectomy can serve to predict which patients are at high risk of bearing residual prostatic carcinoma despite their initial attainment of undetectable PSA serum levels. This report updates previous results to a mean follow-up period of 37 months. The initial results are essentially confirmed in that a mean PSA elimination half-life of 1.6 days in patients considered to be cured at least 24 months after prostatectomy provides additional useful information for predicting outcome in patients with potentially curable prostate cancer.

Analysis of criteria for grading bladder cancer in urine cytological tumor diagnosis by means of an expert system.

An inductive expert system was used for the analysis of criteria for grading bladder carcinoma in urine cytological tumor diagnosis. This analysis seems necessary in order to provide a better standardization of grading and to avoid tumor grades, which are rather inhomogeneous with respect to morphology and prognosis. The analysis of the database by the inductive system shows a considerable variation of the cytomorphology of different bladder carcinomas graded as G2 tumors, whereas G1 and G3 tumors are more homogeneous groups respectively. Especially nuclear morphological criteria are important features for the detection of highly differentiated carcinomas, whereas nucleolar features might be helpful to assess the proliferative nature of the carcinoma. The future goal of avoiding a grading system with prognostically inhomogeneous tumor grades seems possible when using an inductive expert system for consultation.